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12 steps towards recovery: Can engaging in support programs help with alcohol use disorder?

The Bottom Line

  • Approximately six million Canadians are classified as heavy drinkers, a behaviour that can lead to alcohol use disorder, which is associated with disability and early death.  
  • Recovery and support programs such as Alcoholics Anonymous (AA) and similar Twelve-Step Facilitation (TSF) interventions are available to help people struggling with alcohol misuse and dependence. 
  • Compared to other commonly recognized treatments such as cognitive behavioural therapy, standardized AA/TSF programs are better at increasing abstinence and may be equally as effective at reducing alcohol-related consequences. 
  • Consider exploring an AA support group in your community or consulting with a health care provider for guidance about available recovery support programs. 
  • Suggest recovery support programs to loved ones struggling with alcohol use disorder. 

Dinner parties, weddings, vacations, and nights out with friends. These are just a few examples of common activities that often involve or encourage the consumption of alcohol. But just how prominent is drinking culture in Canada? Well, an estimated 80% of Canadians consume alcohol (1). Amongst those who drink, nearly six million engage in heavy drinking (2). For females, this translates into drinking four or more alcoholic beverages during one event, at least once a month, while for males, that number is five or more drinks (3). Heavy drinking can lead to the development of alcohol use disorder, a behavioural condition that gives rise to cognitive, emotional, and physical issues that increase disability and decrease lifespan (4-7).


A diverse collection of treatment options, such as medications, psychological therapies, and recovery support programs, exist to help those struggling with alcohol misuse and dependence achieve and maintain abstinence (4;6). In particular, recovery support programs are appealing because they are widely available and often offered at little to no cost (6;8;9). Alcoholics Anonymous (AA), a group-based 12-step program that focuses on peer-to-peer support and is delivered within community settings, is one example of this type of service (6;10). Overtime, AA has inspired the development of professionally-led Twelve-Step Facilitation (TSF) programs whose main goal is to connect people to AA groups in their community (6;11).


We know that these types of programs are popular. So, should you join the millions of folks using them or advocate their use to loved ones? A recent systematic review took on the task of evaluating the effects of these programs in people battling alcohol use disorder, alcohol abuse, or alcohol dependence (6).


What the research tells us

It was found that people engaging in peer-led AA/professionally-led TSF programs that follow standardized guidelines for delivery are anywhere from 3% to up to 42% more likely to abstain from alcohol use compared to people using other recognized treatments—such as cognitive behavioural therapy (e.g., CBT). These AA/TSF programs may also be as effective as other recognized treatments—such as CBT—in reducing alcohol-related consequences (e.g., mental, physical, and social impacts). Additionally, AA/TSF programs may potentially be more beneficial or equally as beneficial for outcomes such as percentage of days abstinent (long-term), drinking intensity (e.g., drinks consumed per drinking day or percentage of days heavy drinking), and addiction severity. However, our confidence in the findings for these last three outcomes is quite low given the small number of studies and the small number of participants, so more research is needed before more definitive conclusions can be drawn.


These results, coupled with the likelihood that community support programs are more easily accessible than other treatment options, illuminate why AA and similar interventions are indeed popular and worth a try or suggestion to a loved one (6). If you’re personally in need of support, speak with your health care provider about suggestions for programs or search online for ones available in your community. You might find that many in-person programs have been cancelled due to the ongoing COVID-19 pandemic. However, many of them are being offered virtually though platforms like Zoom instead.

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References

  1. Government of Canada. Alcohol. Internet [2020]. [cited January 2021]. Available from https://www.canada.ca/en/health-canada/services/substance-use/problematic-alcohol-use.html 
  2. Statistics Canada. Heavy drinking, by age group. Internet [2021]. [cited January 2021]. Available from https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310009611     
  3. Statistics Canada. Health fact sheets: Heavy drinking, 2018. Internet [2019]. [cited January 2021]. Available from https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00007-eng.htm 
  4. Minozzi S, Saulle R, Rösner S. Baclofen for alcohol use disorder. Cochrane Database Syst Rev. 2018; 11:CD012557. doi: 10.1002/14651858.CD012557.pub2. 
  5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th Edition. Washington, DC: American Psychiatric Association, 2013. 
  6. Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database Syst Rev. 2020; 3:CD012880. doi: 10.1002/14651858.CD012880.pub2.      
  7. Stahre M, Roeber J, Kanny D, et al. Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Prev Chronic Dis. 2014; 11:E109. doi: 10.5888/pcd11.130293. 
  8. White WL, Kelly JF, Roth JD. New addiction recovery support institutions: Mobilizing support beyond professional addiction treatment and recovery mutual aid. J Groups Addict Recover. 2012; 7(2-4):297-317. doi: 10.1080/1556035X.2012.705719.  
  9. Alcoholics Anonymous. Alcoholics Anonymous: The story of how thousands of men and women have recovered from alcoholism. 4th edition. New York (NY): Alcoholics Anonymous World Services, 2001.
  10. Kelly JF, McCrady BS. Twelve-step facilitation in non-specialty settings. In: Research on alcoholism: Alcoholics Anonymous and spiritual aspects of recovery. New York, NY: Springer, 2009:797-836.
  11. Humphreys K. Professional interventions that facilitate 12-step self-help group involvement. Alcohol Res Health. 1999; 23(2):93-98.

DISCLAIMER: Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of these blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations such as social distancing and frequent hand washing. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with current social distancing recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.

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